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Stress may make you a candidate for broken heart syndrome

A relatively new described diagnosis can mimic a heart attack and is most commonly found to affect women

Some people thrive on stress. Others accept stress as a normal part of everyday life. A select few, however, stress to such an extent they can develop a condition known as takotsubo cardiomyopathy — also known as broken heart syndrome.

This condition, which can mimic heart attack symptoms, strikes mostly women. With proper medical care, there's a good chance of full recovery.

"It's a relatively new, described diagnosis," Dr. Robert Quintos, a cardiologist at Providence Health & Services in Portland, said. "It was first described by a Japanese group in the early 90s, but since then, after their initial description, there have been more and more cases that seem to fit this description."

While symptoms of takotsubo cardiomyopathy can resemble those of a heart attack, it's not, Quintos said, a heart attack in the traditional sense of the word.

Quintos added, "When we think about heart attack, typically we're talking about a clot formation in one of the blood vessels or a blocked artery, kind of clogged with cholesterol."

Describing takotsubo cardiomyopathy, Quintos said, "It's a transient stunning of the heart muscle wall itself, which results in, basically, a failure of the pumping mechanism of the heart. In the vast majority of the cases, the heart muscle-pumping function returns to normal."

Quintos said women are mostly affected by takotsubo cardiomyopathy.

"It's predominately women," Quintos said. "Actually, about 90 percent of all reported cases are in women." The average age of women with this condition would be the early 60s.

"If you look at patients who come in with heart attack symptoms — somewhere between 1 percent and 2 percent of those patients end up having takotsubo cardiomyopathy rather than a true heart attack," according to Quintos.

There are a number of symptoms to look for, including chest pain, shortness of breath, light headedness, dizziness and sweating. "If you are having any of those symptoms, regardless of whether you're stressed or not, naturally you need to call 911," Quintos said.

There are many physical and emotional triggers of takotsubo cardiomyopathy, including infection, illness and surgery aftermath.

But, according to Quintos, "emotional stress is definitely one that's been described, including death of a loved one."

In fact, there have been cases where an elderly man or woman dies shortly after their spouse passes away.

"Death of a loved one is actually a fairly common trigger for this episode," Quintos said.

Whether it's the death of a loved one or another form of stress, "It has been shown that people who have chronic stressors or chronic anxiety disorder, for instance, seem to have a higher disposition to this takotsubo cardiomyopathy," Quintos pointed out, noting that, generally, stress contributes to heart disease.

He said long-term studies suggest that people with higher stress have higher rates of high blood pressure, abnormal heart rhythms, heart attacks and cardiac arrest.

A patient with a diagnosis of takotsubo cardiomyopathy has a good chance of full recovery, although the recurrence rate is between 1 percent and 2 percent per year.

"If you can get them through the initial phase, the vast majority of people completely recover their heart function in the next two to four weeks," Quintos said.

Medications for this syndrome are similar to medications used for general congestive heart failure. "There are some medications that help with pumping function," Quintos said. "They may need a water pill because these patients tend to retain water. Many of these treatments may just be temporary, just kind of holding them over until their heart function improves."

If you're concerned about the amount of stress in your life, have a talk with your primary care doctor.

"The effects of stress, I think, are underestimated," Quintos said. "Stress, definitely, has real physiologic consequences - if you do feel highly stressed or highly anxious, those things should be addressed."

While it's not known precisely why takotsubo cardiomyopathy occurs, Quintos said, "I think the number one thing is to pay attention to your body and pay attention to symptoms. The second thing is stress is real. Stress has real consequences - definitely work on reducing stress in your life."

WAYS TO RELIEVE STRESS

Get active

Virtually any form of physical activity can act as a stress reliever. Even if you're not an athlete or you're out of shape, exercise can still be a good stress reliever.

Physical activity can pump up your feel-good endorphins and other natural neural chemicals that enhance your sense of well-being. Exercise can also refocus your mind on your body's movements, which can improve your mood and help the day's irritations fade away. Consider walking, jogging, gardening, housecleaning, biking, swimming, weightlifting or anything else that gets you active.

Eat a healthy diet

Eating a healthy diet is an important part of taking care of yourself. Aim to eat a variety of fruits and vegetables, and whole grains.

Avoid unhealthy habits

Some people may deal with stress by drinking too much caffeine or alcohol, smoking, eating too much, or using illicit substances. These can affect your health in unhealthy ways.

Meditate

During meditation, you focus your attention and quiet the stream of jumbled thoughts that may be crowding your mind and causing stress. Meditation can instill a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health.

Guided meditation, guided imagery, visualization and other forms of meditation can be practiced anywhere at any time, whether you're out for a walk, riding the bus to work or waiting at the doctor's office.

Laugh more

A good sense of humor can't cure all ailments, but it can help you feel better, even if you have to force a fake laugh through your grumpiness. When you laugh, it not only lightens your mental load but also causes positive physical changes in your body. Laughter fires up and then cools down your stress response. So read some jokes, tell some jokes, watch a comedy or hang out with your funny friends.

Connect with others

When you're stressed and irritable, your instinct may be to wrap yourself in a cocoon. Instead, reach out to family and friends and make social connections.

Try yoga

With its series of postures and controlled-breathing exercises, yoga is a popular stress reliever. Yoga brings together physical and mental disciplines which may help you achieve peacefulness of body and mind. Yoga can help you relax and manage stress and anxiety.

Try yoga on your own or find a class — you can find classes in most communities. Hatha yoga, in particular, is a good stress reliever because of its slower pace and easier movements.

Get enough sleep

Stress can cause you to have trouble falling asleep. When you have too much to do — and too much to think about — your sleep can suffer. But sleep is the time when your brain and body recharge.

And the quality and amount of sleep you get can affect your mood, energy level, concentration and overall functioning. If you have sleep troubles, make sure that you have a quiet, relaxing bedtime routine, listen to soothing music, put clocks away, and stick to a consistent schedule.

— mayoclinic.org

Scott Keith is a freelance writer for the Portland Tribune and the Pamplin Media Group. If you have a health tip, or a story idea, contact Scott at This email address is being protected from spambots. You need JavaScript enabled to view it..